OBJECTIVES: To explore the difference in CT values between pulmonary thromboembolism and postmortem clot in postmortem CT pulmonary angiography (CTPA) to further improve the application value of virtual autopsy. METHODS: Postmortem CTPA data with the definite cause of death from 2016 to 2019 were collected and divided into pulmonary thromboembolism group (n=4), postmortem clot group (n=5), and control group (n=5). CT values of pulmonary trunk and left and right pulmonary artery contents in each group were measured and analyzed statistically. RESULTS: The average CT value in the pulmonary thromboembolism group and postmortem clot group were (168.4±53.8) Hu and (282.7±78.0) Hu, respectively, which were lower than those of the control group (1 193.0±82.9) Hu (P<0.05). The average CT value of the postmortem clot group was higher than that of the pulmonary thromboembolism group (P<0.05). CONCLUSIONS CT value is reliable and feasible as a relatively objective quantitative index to distinguish pulmonary thromboembolism and postmortem clot in postmortem CTPA. At the same time, it can provide a scientific basis to a certain extent for ruling out pulmonary thromboembolism deaths.
Humans ; Autopsy ; Thrombosis ; Pulmonary Embolism/diagnostic imaging* ; Tomography, X-Ray Computed ; Angiography ; Cadaver

Hepatocelluar carcinoma presenting as a biliary duct tumor thrombus is a relatively rare entity, with poor prognosis. The primary clinical manifestation of this disease is obstructive jaundice, which can often be misdiagnosed. A 59-year-old female patient was admitted with sudden onset of abdominal pain. Laboratory tests suggested obstructive jaundice, and enhanced magnetic resonance imaging of the upper abdomen did not show obvious biliary dilatation. Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography suggested an occupying lesion in the upper bile duct. SpyGlass and biopsy finally confirmed hepatocellular carcinoma with right hepatic duct tumor thrombus hemorrhage. The SpyGlass Direct Visualization System, as an advanced biliary cholangioscopy device, showed the advantages of single-person operation as well as easy access to and visualization of the lesion.
Female ; Humans ; Middle Aged ; Carcinoma, Hepatocellular/diagnostic imaging* ; Jaundice, Obstructive/etiology* ; Liver Neoplasms/diagnostic imaging* ; Hepatic Duct, Common/pathology* ; Thrombosis/complications* ; Hemorrhage/complications*

Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated vasculitis is an autoimmune disease usually with severe multiple dysfunction syndrome, especially prominent acute renal failure. A 65-year-old woman was admitted with progressive dyspnoea for six months and fever, sputum with blood, pain of the lower extremities and intermittent claudication for two days, indicating multiple organ involvement (respiratory system, blood vessels). The renal involvement was relatively mild, presenting with microscopic haematuria. The chest computed tomography demonstrated multiple pulmonary embolisms. Ultrasound and computed tomography angiography for the lower extremity vessels showed venous and arterial thrombosis. Exclusion of other diseases that can cause multiple organ damage and thrombosis, the positive perinuclear ANCA and MPO-ANCA strongly support the diagnosis of MPO-ANAC-associated vasculitis. The patient's physical condition has been greatly improved by treatment with corticosteroids and anticoagulation.
Aged ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis* ; Female ; Humans ; Lower Extremity/diagnostic imaging* ; Peroxidase ; Pulmonary Embolism/diagnostic imaging* ; Thrombosis

Atrial Appendage/diagnostic imaging* ; Atrial Fibrillation ; Cardiac Catheterization ; Echocardiography, Transesophageal ; Humans ; Thrombosis/etiology* ; Treatment Outcome

Spontaneous regression of tumors is an extremely rare event in hepatocellular carcinoma (HCC) with only a few reports available. With the accumulation of clinical information and tumor immunogenetics, several mechanisms for the cystic changes of HCC have been suggested, including arterial thrombosis, inflammation, and rapid tumor growth. This paper reports an uncommon case of the partial regression of HCC, which was initially misdiagnosed as a mucinous cystic neoplasm of the liver due to the unusual radiologic findings. A 78-year-old female with the hepatitis B virus and liver cirrhosis presented with an approximately 5 cm-sized cystic mass of the liver. From the radiologic evidence of a papillary-like projection from the cyst wall toward the inner side, the initial impression was a mucinous cystic neoplasm of the liver. The patient underwent a surgical resection and finally, cystic degeneration of HCC, in which approximately 80% necrosis was noted. This case suggests that if a cystic neoplasm of liver appears in a patient with a high risk of HCC on a hepatobiliary imaging study, it is prudent to consider the cystic degeneration of HCC in a differential diagnosis.
Aged ; Carcinoma, Hepatocellular ; Diagnosis, Differential ; Diagnostic Errors ; Female ; Hepatitis B virus ; Humans ; Immunogenetics ; Inflammation ; Liver ; Liver Cirrhosis ; Liver Neoplasms ; Magnetic Resonance Imaging ; Mucins ; Necrosis ; Thrombosis

Spontaneous regression of tumors is an extremely rare event in hepatocellular carcinoma (HCC) with only a few reports available. With the accumulation of clinical information and tumor immunogenetics, several mechanisms for the cystic changes of HCC have been suggested, including arterial thrombosis, inflammation, and rapid tumor growth. This paper reports an uncommon case of the partial regression of HCC, which was initially misdiagnosed as a mucinous cystic neoplasm of the liver due to the unusual radiologic findings. A 78-year-old female with the hepatitis B virus and liver cirrhosis presented with an approximately 5 cm-sized cystic mass of the liver. From the radiologic evidence of a papillary-like projection from the cyst wall toward the inner side, the initial impression was a mucinous cystic neoplasm of the liver. The patient underwent a surgical resection and finally, cystic degeneration of HCC, in which approximately 80% necrosis was noted. This case suggests that if a cystic neoplasm of liver appears in a patient with a high risk of HCC on a hepatobiliary imaging study, it is prudent to consider the cystic degeneration of HCC in a differential diagnosis.
Aged ; Carcinoma, Hepatocellular ; Diagnosis, Differential ; Diagnostic Errors ; Female ; Hepatitis B virus ; Humans ; Immunogenetics ; Inflammation ; Liver ; Liver Cirrhosis ; Liver Neoplasms ; Magnetic Resonance Imaging ; Mucins ; Necrosis ; Thrombosis

BACKGROUND: Venous thromboembolism (VTE) is a recognized complication in lung cancer patients with higher morbidity and mortality. The purpose of this study is to determine the incidence of lower extremity venous thrombosis (LEDVT) in lung cancer patients and to reveal the risk factors for LEDVT during admission in our center. METHODS: We first connected 231 patients with lung cancer admitted to the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital from July 2017 to December 2017. All these patients underwent color ultrasound examination of lower extremity vein on admission to analyze the incidence of LEDVT. At the same time, the incidence of LEDVT in patients with benign lung diseases on admission was used as control. In order to explore the possible risk factors for LEDVT in these patients with lung cancer, we further analyze the correlations between LEDVT and their clinical features. At the same time, we also analyze the relationship between LEDVT and Plasma D-Dimmer, fibrinogen (FIB), thrombin time (TT), activated partial thrombin time (APTT), prothrombin time (PT) and platelet (PLT) in these patients with lung cancer. RESULTS: Among 231 patients with lung cancer, the incidence rate of LEDVT on admission was 5.2% (12/231), and in 77 patients with benign lung disease, there was none of patients with LEDVT on admission. This result indicated that the admitted incidence rate of LEDVT in patients with lung cancer was significantly higher than that in patients with benign lung disease (P<0.05). Further analysis in patients with lung cancer found that there was higher incidence rate of LEDVT in distant metastasis group (including N3 lymph node metastasis) compared to in non-distant metastasis group (11.29%, 7/62 vs 2.96%, 5/169) (P<0.05). In patients with lung cancer, the median value of D-Dimer in LEDVT group was 1,534 mg/L (369 mg/L-10,000 mg/L), which was significantly higher than that in the non-LEDVT group (539 mg/L, 126 mg/L-1,000 mg/L) (P<0.05). There was no statistically significant difference in FIB, TT, APTT, PT and PLT between these two groups (P>0.05). CONCLUSIONS The overall incidence of LEDVT in our central lung cancer patients was approximately 5%, significantly higher than that in patients with benign lung disease. Lung cancer patients with distant metastasis (including N3 lymph node metastasis) at admission were more likely to develop LEDVT, and these patients with higher D-Dimer values should be considered the possibility of VTE events.
Female ; Humans ; Incidence ; Lower Extremity ; Lung Neoplasms ; surgery ; therapy ; Male ; Middle Aged ; Patient Admission ; Risk Factors ; Tomography, X-Ray Computed ; Venous Thrombosis ; diagnostic imaging ; etiology

Cerebral venous sinus thrombosis (CVST) is a rare condition in early pregnancy. A 22-year-old Chinese woman at 10 weeks of pregnancy requested induced abortion and was diagnosed as CVST for a severe headache accompanying with nausea and vomiting. The patient was treated successfully with anticoagulation, followed by amniocentesis, and finally succeeded in induction of labor safely. The diagnosis, treatment and prognosis for this rare condition are discussed in this paper.
Adult ; Female ; Humans ; Labor, Induced ; Pregnancy ; Pregnancy Trimester, Second ; Prognosis ; Sinus Thrombosis, Intracranial ; diagnosis ; diagnostic imaging ; drug therapy ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND: Non-small cell lung cancer with left atrial tumor thrombus accounts for a small proportion of local advanced lung cancer. Whether surgery could bring benefits, as well as surgical options are still controversial, and have always been hot spots in surgical research. We report a single center experience of surgical treatment to non-small cell lung cancer with left atrial tumor thrombus, aim to figure out more reasonable treatment strategy. METHODS: From August 2006 to July 2017, a total of 11 cases of non-small cell lung cancer with left atrial tumor thrombus underwent surgery in Thoracic Surgery Department of China-Japan Friendship Hospital. Clinical data, treatment options, pathological types and prognosis of these patients were collected to perform a retrospective study. RESULTS: Of the 11 patients (mean age of 57.9), 7 were men and 4 were women. Six of them received neoadjuvant radiotherapy and/or chemotherapy. All patients underwent smooth operation, including 3 cases with cardiopulmonary bypass, 1 case of posterolateral approach under extracorporeal membrane oxygenation, 6 cases of conventional posterolateral approach and 1 case of video-assisted minithoracotomy. Nine patients were evaluated as R0 resection while 2 cases were evaluated as R1 resection. The Surgeries cost an average of 292 min (210 min-380 min), with an average of 436 mL (100 mL-1,600 mL) blood loss. One patient (9.1%) died within 90 days after surgery, and another 4 cases (36.4%) suffered postoperative complications such as arrhythmia, cerebral infarction or hypoxemia. Six cases of squamous cell carcinoma, 4 cases of adenocarcinoma and 1 case of sarcomatoid carcinoma were identified by pathology. Seven cases were staged as pT4N0M0 while 4 cases were staged as pT4N1M0. Nine patients underwent adjuvant chemotherapy, and two patients underwent radiotherapy during follow-up. The overall follow-up time was 2 to 53 months, the 3-year disease-free survival rate was 30.7%, the median disease-free survival time was 31 months, the 3-year overall survival rate was 49.1% and the median overall survival time was 33 months. CONCLUSIONS For selected patients of non-small cell lung cancer complicated with left atrial tumor thrombus, choose a reasonable surgical approach to resect both the tumor and the thrombus, strengthen the perioperative management and apply neoadjuvant/adjuvant radiotherapy and/or chemotherapy, might obtain satisfying prognosis.
Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; complications ; diagnostic imaging ; surgery ; Disease-Free Survival ; Female ; Heart Atria ; Humans ; Lung Neoplasms ; complications ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Perioperative Period ; Retrospective Studies ; Thrombosis ; complications ; Tomography, X-Ray Computed

Dural sinus thrombosis (DST), or cerebral venous thrombosis, is an uncommon cause of stroke. It has a variable presentation, and the symptoms and signs can be non-specific. The diagnosis of DST can be difficult to make and is often delayed or missed. Computed tomography venography or magnetic resonance venography are the typical imaging modalities used to diagnose DST. However, computed tomography venography and magnetic resonance venography both have limitation for emergency department patients. In this article, we report the use of point-of-care ultrasound to facilitate the diagnosis of DST.
Diagnosis ; Diagnostic Imaging ; Emergencies ; Emergency Service, Hospital ; Humans ; Phlebography ; Point-of-Care Systems* ; Sinus Thrombosis, Intracranial* ; Stroke ; Thrombosis ; Ultrasonography* ; Venous Thrombosis